What is the difference between endometriosis and adenomyosis?

09 Dec What is the difference between endometriosis and adenomyosis?

What is adenomyosis

Adenomyosis is a condition in which the cells that are normally found in the internal lining of the uterus (endometrial cells) are found within the muscle of the uterus. As these cells are hormonally responsive, they grow with estrogen and lead to a bulkier uterus and heavy periods, and become less active with progesterone or when there is low estrogen level such as after menopause.

How is it different to endometriosis 

Endometriosis is a condition where the same endometrial cells are found outside the uterus, such as in the pelvis and ovaries. Endometriosis is common among women and may lead to period pain and reduced fertility. 

How do I know if I have adenomyosis 

Women with adenomyosis may experience heavy periods. Adenomyosis may also be found incidentally on imaging such as ultrasound or MRI performed for other reasons. The uterus may be bulkier than normal due to adenomyosis. In many cases, adenomyosis affects either a large part of the uterus or, the entire uterus. Occasionally, it can affect only a particular part of the uterus, forming a mass – called an adenomyoma. Adenomyoma may be mistaken for a fibroid – which is the commonest benign tumour arising from the muscle of the uterus. 

How is adenomyosis treated 

The treatment of adenomyosis depends on the severity of the symptoms experienced. It may not need any active treatment if it does not cause symptoms such as heavy or painful periods. 

Heavy periods are commonly and successfully treated with hormonal medications such as the contraceptive pill or with progesterone treatments such as oral progesterone or progesterone releasing IUD (intrauterine device). Progesterone counters the estrogen effect on endometrial cells and makes them less active, leading to lighter and less painful periods. 

Surgical options to remove adenomyosis are limited by the infiltrative nature of the condition and it is best to consult a gynaecologist. As it usually affects a large component, if not all of the uterus, removing the entire uterus (hysterectomy) is the only way to remove it completely. This is offered only after more conservative options are not successful, and only in women who are not contemplating further pregnancies.